Suicide

If you are reading this because you are feeling suicidal, it is important that you seek help immediately.

Many people who have felt suicidal at some point say they were so overwhelmed by negative feelings that they saw no option other than suicide. However, with the right treatment and support, the same people were able to carry on with their life and the negative feelings passed.

Getting help if you feel suicidal

If you are feeling suicidal, you can:

call the Samaritans support service on 116123. Samaritans is available 24 hours a day, 7 days a week for anyone struggling to cope. For confidential, non-judgemental support;

go to your nearest accident and emergency (A&E) department and tell the staff how you are feeling

speak to a friend, family member or someone you trust

make an urgent appointment to see your GP

Worried someone else is suicidal

If you are worried that someone you know may be considering suicide, recommend that they contact one or more of the organisations above and encourage them, in a non-judgemental way, to talk about how they are feeling.

If the person has previously been diagnosed with a mental health condition, such as depression, you can speak to a member of their care team for help and advice.

Why do some people take their own life?

There is no single reason why someone may try to take their own life, but certain factors or problems may make suicide more likely.

A person may be more likely to become suicidal if they have a mental health condition, such as:

depression

anorexia nervosa

bipolar disorder

anxiety disorder

schizophrenia

borderline personality disorder

Other factors that can increase the chances of a person attempting to end their life include:

misusing drugs

misusing alcohol

being unemployed

being male and under 35 years of age

How common is suicide?

Suicide is a leading cause of death, particularly in young people, both in Ireland and worldwide.There are approximately 500 suicides recorded each year in Ireland .Suicide rates are three times higher in men than in women.

Suicide is a leading cause of death, particularly in young people, both in Ireland and worldwide. It is estimated that around 1 million people will die by suicide worldwide each year. Provisional figures for 2010 indicate that there were 486 deaths by suicide recorded.It is likely that the final figure will be higher

Attempted suicides are much more common than actual suicides. There are about 12000 attempted suicides each year in Ireland .

Gender

Women are more likely to attempt suicide or engage in other types of self-harming behaviour. However, men are more likely to succeed and die by suicide. Suicide rates are three times higher in men than in women.

Men under the age of 35 are particularly at risk of dying by suicide. Suicide is the second most common cause of death in this age group, after accidental death.

Age

Cases of suicide have been reported in people of all ages, including children, but suicide or attempted suicide are more common in certain age groups.

In men, suicide is more common in people who are 15-44 years of age, and particularly in men who are 15-24 years old. Men who are 45 years of age or over have a lower risk of committing suicide.

In women, suicide is more common between the ages of 45 and 74. Younger women between the ages of 15 and 24 are thought to have a low risk of suicide.

Despite being a leading cause of death, both in Ireland and worldwide, there is little hard evidence to explain why some people commit suicide while other people in similar circumstances do not. However, some important factors that make suicide more likely have been identified. These are explained below.

Vulnerability to suicide

Many experts believe that several factors determine how vulnerable a person is to suicidal thinking and behaviour.

Factors that make someone more vulnerable include:

genetics and family history - see below

life history - for example having a traumatic experience during childhood, such as a bereavement

lifestyle - people who misuse alcohol and drugs are at increased risk of suicidal thoughts

job - poor job security, low levels of job satisfaction or not having a job can increase a person's risk of dying by suicide

relationships - people who are socially isolated and have few close relationships with others have a higher risk of dying by suicide

As well as these factors, one or more stressful events may push a person "over the edge" and lead to suicidal thinking and behaviour. The amount of stress it takes to do this will depend on the person's level of vulnerability.

In some cases, it may only take a minor event, such as having an argument with a partner. In other cases, it may take one or more very stressful or upsetting events before a person feels suicidal, such as a partner dying or being diagnosed with a terminal illness.

In many cases, it may take a combination of different factors to increase a person's risk of suicidal thoughts.

Mental health conditions

Having a mental health condition is the most significant risk factor for suicide.

It is estimated that 90% of people who attempt or die by suicide have one or more mental health conditions. The mental health conditions that lead to the biggest risk of suicide are described below.

Severe depression

Severe depression is where a person has severe symptoms of despair and hopelessness that interfere with their life. People with severe depression are 20 times more likely to attempt suicide than the general population.

Bipolar disorder

Bipolar disorder is where a person swings from feeling very high and happy to feeling very low and depressed. About 1 in 3 people with bipolar disorder will attempt suicide at least once, and 1 in 10 people with the condition will take their own life.

Schizophrenia

Schizophrenia is a long-term mental health condition that causes hallucinations (seeing or hearing things that are not real), delusions (believing in things that are not true) and changes in behaviour. It is estimated that 1 in 20 people with schizophrenia will take their own life.

People with schizophrenia are most at risk of suicide when their symptoms first begin. The risk reduces as they learn to cope with their condition.

Borderline personality disorder

Borderline personality disorder is characterised by unstable emotions, disturbed thinking patterns, impulsive behaviour and intense but unstable relationships with other people. It is estimated that just over half of people with borderline personality disorder will make at least one suicide attempt.

People with a borderline personality disorder who have a history of childhood sexual abuse have a particularly high risk of suicide.

Anorexia nervosa

Anorexia nervosa is where a person is very anxious about their weight and keeps it as low as possible by strictly controlling and limiting what they eat. It is estimated that around 1 in 5 people with anorexia will make at least one suicide attempt.

Generalised anxiety disorder

Generalised anxiety disorder is where a person has persistent, recurring feelings of stress and anxiety.

Other risk factors for suicide

Other factors that can increase the risk of suicide include:

having a history of sexual or physical abuse

having a history of parental neglect, either emotional or physical neglect or both

having a parent with a serious mental health condition, such as severe depression or schizophrenia

having a parent who died by suicide

having previously attempted suicide

being socially isolated, such as living alone or having few close friends or family members

being gay, arising from the prejudice that gay people often face

being unemployed, having poor job security or working in an unskilled occupation

being in debt

being homeless

being recently released from prison

having recently experienced a traumatic event, such as the end of a relationship or the death of a loved one

misusing drugs or misusing alcohol

working in an occupation that provides access to potential ways of dying by suicide, such as working as a doctor, nurse, pharmacist, farmer or as member of the armed services

Antidepressants and suicide risk

Research has found that young people under 25 years of age have a small increased risk of suicide or having suicidal thoughts when taking antidepressants, usually when they first begin treatment.

Contact your GP immediately or go to your local hospital if you have thoughts of killing or harming yourself at any time while taking antidepressants.

It may be useful to tell a relative or close friend that you have started taking antidepressants and to ask them to read the leaflet that comes with your medication. Ask them to tell you if they think your symptoms are getting worse or if they are worried about changes in your behaviour.

Genetics and suicide

It has been known for some time that suicide can run in families. This has led to speculation that certain genes may be associated with suicide.

Recent research has identified several genetic mutations that may disrupt the chemical make-up of the brain, making a person more vulnerable to suicidal thinking and behaviour.

A mutation is where the normal genetic instructions inside the cells become scrambled so that some cells do not work in the way that they should. However, it would be too simple to claim that there is a "suicide gene" and that whoever had a copy of that gene would attempt suicide.

Suicide is not just a matter of biology. It is a complex phenomenon and a wide range of factors is involved. However, a better understanding of the genetics associated with suicide may eventually make it possible to screen people who are at risk and to provide them with treatment and support.

A newer theory of suicide

A newer theory about suicide, devised by an American psychologist called Charles Joiner, states that three main factors can cause someone to turn to suicide. They are:

a perception (usually mistaken) that they are alone in the world and that no one really cares about them

a feeling (again usually mistaken) that they are a burden on others and that people would be better off if they were dead

fearlessness towards pain and death

The last factor poses the biggest risk that someone will go through with a successful suicide attempt.

The theory argues that fearlessness towards pain and self-harm may be learnt over time, which could explain the strong association between self-harming behaviour and suicide.

People who are regularly exposed to the suffering and pain of others may develop this fearlessness over time. This could help explain why suicide rates are higher in occupations that are linked to such exposure, such as soldiers, nurses and doctors.

High-risk warning signs

actively look for ways to kill themselves, such as stockpiling tablets or buying equipment that could be used to suffocate themselves

talk or write about death, dying or suicide

If the person has been diagnosed with a mental health condition, contact a member of their care team or the centre or clinic where they were being treated.

If you do not have any relevant contact details, contact your nearest accident and emergency (A&E) department and ask for their advice.

While waiting for the person to receive treatment, remove any possible means of suicide from their immediate environment, such as medication, knives or other sharp objects, and household chemicals, such as bleach.

If you think there is a high risk of a person dying by suicide before you can get the appropriate professional help, call 999 and ask for an ambulance.

Other warning signs

A person may also be at risk of attempting suicide if they:

complain of feelings of hopelessness, saying things such as, "What's the point of even trying? I know things are never going to get better"

have episodes of sudden rage and anger

act recklessly and engage in risky activities with an apparent lack of concern about the consequences

talk about feeling trapped, such as saying they cannot see any way out of their current situation

start to abuse drugs or alcohol, or use more than they usually do

become increasingly withdrawn from friends, family and society in general

appear anxious and agitated

are unable to sleep or sleep all the time

have sudden mood swings - a sudden lift in mood after a period of depression could indicate they have made the decision to attempt suicide

talk and act in a way that suggests their life has no sense of purpose

lose interest in their appearance, such as dressing badly, no longer wearing make-up or not washing regularly

put their affairs in order

If you notice any of these warning signs in a friend, relative or loved one, encourage them to talk about how they are feeling.

Also share your concerns with a member of their care team, if they are being treated for a mental health condition, or your GP.

Useful Links

If you have had suicidal thoughts recently, or if you are feeling suicidal now, contact someone for help. Talking to someone can help you see beyond the feelings of loneliness or despair. It can help you realise that there are other options apart from ending your life.There are several telephone helplines with specially trained people who will listen to you, understand what you are going through and help you through the immediate crisis.

Helplines and support groups

Samaritans

Samaritans is available 24 hours a day, 7 days a week for anyone struggling to cope. For confidential, non-judgemental support;

Talking and listening

The best thing you can do if you think someone may be feeling suicidal is probably to encourage them to talk about their feelings and to listen to what they say.

Listen

Talking about someone's problems is not always easy, but you do not have to try to provide a solution to their problems. The most important thing is to listen to what they say to let them know you care.

Do not judge

It is also important to avoid making judgements about how they are thinking and behaving. You may feel that certain aspects of their thinking and behaviour are making their problems worse. For example, they may be drinking too much alcohol. However, pointing this out now will not help them.

Empathise

It is important to empathise with the person, rather than just sympathising with them. There is an important difference between sympathy and empathy. Sympathy is saying, "I understand how you feel" or "Oh, it's awful." Empathy is saying, "I can see that you are not feeling great."

As one expert put it, empathy is recognising how a person feels but not taking ownership of their problem or making a judgement.

Asking questions

Asking questions can be a useful way of letting a person remain in control but allowing them to talk about how they are feeling. Do not try to influence what the person says, but give them the opportunity to talk honestly and openly.

What not to say

Do not ask direct questions because these can often make the person feel threatened. Examples of direct questions include:

Why did you do that?

What are you planning to do now?

Avoid statements that could possibly end the conversation, such as:

I know how you feel.

Try not to worry about it.

What to say

Try to make your questions as open-ended as possible. Examples include:

When did you realise?

Where did that happen?

What else happened?

How did that feel?

What were you thinking at the time?

Looking after yourself

Helping a friend or relative who is feeling suicidal can be very distressing, worrying and stressful. It can have an impact on your own mental health and emotional wellbeing.

You may find it useful to discuss your concerns and feelings with another friend. If you prefer to keep the matter confidential, you can call Samaritans for advice and support on 116123

Getting professional help

If someone has been feeling low for some time, it is a good idea for them to get support, either by talking to a counsellor or getting practical help with their problems.

Coping with suicide

Mental health is similar to physical health. It is impossible to guarantee you will never get a mental health condition, just as you cannot guarantee you will never develop a physical health condition, no matter how healthy you are.

However, you can take steps to improve your mental health and make yourself emotionally stronger and better able to cope with stressful or upsetting incidents. This can reduce your risk of developing a mental health condition, such as depression.

Exercise and diet

Research shows that for some people, exercise can be as effective as antidepressant medication in reducing depressive symptoms, particularly in people with mild and moderate depression. Being physically active helps to:

lift your mood

reduce stress and anxiety

encourage the release of "feel-good" chemicals, called endorphins

improve self-esteem

The National Institute for Health and Clinical Excellence (NICE) recommends that exercise should be used to treat depression in people of all ages.

It is also important to eat a healthy diet. Eating healthily may be as important for maintaining mental health as it is for protecting against physical health problems.

Alcohol

Drinking alcohol can be tempting as a way of trying to cope with problems or unpleasant emotions. However, persistent alcohol misuse can make a person's problems and emotions worse. It can also cause a new set of problems for them to cope with.

Alcohol is a depressant. This means that it can make unpleasant emotions worse, such as sadness and hopelessness.

To avoid common mental health problems associated with alcohol misuse, do not drink more than the recommended daily limits of alcohol. These are:

twenty one standard drinks a week for men

fourteen standard standard drinks a week for women

A standard drink of alcohol is approximately half a pint of normal-strength beer, a small glass of wine or a pub measure of spirits.

See your GP if you have difficulty moderating your alcohol consumption.

Drugs

People with problems or unpleasant emotions also commonly use drugs to cope. However, as with alcohol, persistent drug misuse causes more problems and increases your risk of developing a serious mental health condition, such as depression.

Even drugs that many people consider less harmful, such as cannabis, have been shown to increase the risk of developing conditions such as depression or schizophrenia in some people.

If you find it difficult to stop taking drugs, you may require counselling or medication.

Avoid isolation

Becoming socially isolated is a significant risk factor for suicide. Try to remain engaged as much as possible with the world around you. Talk to someone you trust about how you feel and maintain your friendships and interests, even if you do not feel like it at times.

If you find it difficult to make friends, you may benefit from joining a local activity group, such as a book group or walking group. Your local library, community centre or local council should be able to provide you with details of the various groups and clubs in your community.

Research has also shown that people who regularly spend time helping others through charitable activities or other voluntary work are typically more mentally healthy than the general population. You may benefit from volunteering with a local charity or voluntary organisation.

All charities and most voluntary organisations are grateful for any help. Simply choose an issue that you feel strongly about and contact a relevant organisation. The most effective way of finding and contacting an organisation is on the internet.

Staying positive

Staying positive may sound like a meaningless phrase, particularly to someone with severe depression, but it is important to try and remain as positive as possible.

Persistent negative thinking can mean you risk withdrawing from the world around you and becoming more isolated.

Breaking this pattern usually requires a conscious effort, such as "stepping back" when an event upsets you and considering how you can respond in a more positive way.

If you cannot change negative patterns of thinking, you may benefit from a type of talking treatment called cognitive behavioural therapy (CBT). CBT can help you manage your problems by changing how you think and act.